Table 3

Beliefs about the occurrence of OA

Different ideas about the impact of OA on individuals and collectively.“And when we’ve suspected It [OA], it doesn’t feel like it’s having a massive impact on patient’s lives. They sort of seem to kind of say ‘Oh yeah, I feel a bit wheezy there, but I’m alright when I get home.’” (P3)
“I don’t see lots of people saying, ‘My occupational asthma is ruining my life.’ In that regard, it’s not high up the list of things we worry about. We probably miss a lot of it. Everyone is exposed to all the particulates that around here because we’re in the middle of the inner city and a mile away from an incinerator. I guess that’s more relevant. Around here, a lot of our patients have hard lives. If you said to my colleagues, ‘Give us a list of your Top 10 things you’re worried about,’ occupational asthma would not be on it.” (P4)
“There’s no doubt I’m sure it is very significant to somebody who has got it, and it’s got to have a societal impact if it’s stopping people working, especially those in skilled jobs, who we need doing those jobs. If they can’t work then that’s clearly got a societal impact.” (P1)
“But I think it is important though, it is certainly important because it affects a person in their prime when they can work and it is going to impact on their living and day to day activities. They can’t even offer to take time off to come and see the GPs, you know, to get appointments so it certainly has.” (P8)
Work-related symptoms are trivial.“The only thing would be, occasionally, patients, will say you know ‘Since I’ve worked in that factory, I don’t like the smell of the paint’ or that sort of thing… But I have to say, I’ve never taken it very seriously if people say things like that.” (P2)
Work exposures trigger, not cause, asthma in susceptible individuals.“One of the problems actually is I think my belief is that you are kind of born with a susceptibility to it [asthma], we can all be pushed to wheeze if we’re pushed far enough; but that your tendency to wheeze is sort of what you’re born with, and it’s sort of an endogenous thing, and not to do with what you’re exposed to in the future.” (P2)
“I’ve always been sort of historically [sic] you’ve had a tendency and that’s the trigger. But in terms of it actually bringing it all on, I’ve never really thought about that, no. I guess you can get sensitised to stuff and presumably react and whatever.” (P3)
Onset of asthma in adult life is not unusual.“I don't think that’s a prevalent view amongst GPs [that adult-onset asthma is unusual]. It’s a bit like if someone comes in with hypertension, you don’t necessarily go back to saying, ‘Have you really got hypertension?’“ (P4)
“We were always told asthma could come on at any time at any time of life and not that it was unusual. It’s made me think more about when it is adult asthma we should be looking more into occupation.” (P6)
OA is not prevalent in the local patient population.“I don’t know how many cases that might be occupational we would have in our registered population, but presumably none of us are seeing that many of them. I don’t think the area that we are in, there isn’t much industry which would be relevant.” (P1)
“A lot of our patients don’t work. They might be working age but a lot of them aren’t actually employed… Even a practice this size, I’d be surprised if we have 20 patients for whom occupational asthma is their main diagnosis. That’s as rare as all the kids we’ve got with genetic disease.” (P4)
“This is rare stuff for us I would say. One in 6 [occurrence of OA amongst asthmatics] was a surprise, I would’ve said if it was 1 in 6 in our population we’ll be missing a lot. Yeah, it’s a rare diagnosis. That’s hard though because it is rarer in our environment because we haven’t got a lot of people that work in industry as such, or we’re missing a lot.” (P11)
OA is underestimated in primary care.“I think it seems to be very underestimated. You hear a lot about smoking and the impact that not smoking in public places has done and actually it’s things like people not wearing masks in various jobs that they do.” (P7)
“Well I know the statistics are slightly that GPs undermanage existing asthma, and there’s a lot of talk that we over-diagnose, but we also under-diagnose. So we’re not very good at screening out the right people. And I know there’s been a lot of fuss about that recently. So that makes me think do we do under-diagnose, so maybe there are people out there that we haven’t really sort of sorted out… But if you ask me is it occupational, well now I’m beginning to think ‘What am I missing?’ But I would’ve just thought ‘Oh, it’s asthma’. I wouldn’t attribute it to triggers very often.” (P2)
OA is a historical problem or associated with traditional industry.“I do think of it as a slightly historical thing, as we were saying, because you think surely in this day and age health and safety, you wouldn’t be allowed to do it if it was that dangerous. But you certainly come across people working long hours or doing repetitive things and they get muscular skeletal conditions, people stressed by poor management. So actually, there is quite a lot of work-related stuff, but in terms of respiratory, the only things that I can think of causing a problem are more an allergy. I was thinking farmers, farm workers… I think of occupational respiratory problems as the asbestosis and coal mining, those sorts of things. So, it barely enters my consciousness really.” (P2)
“I’d be more surprised if someone pitched up and said, ‘I’m in a cabinet with no mask and they’re pumping this gas through.’ Whereas 20 years ago, that was probably commonplace, I guess.” (P4)
  • GP, general practitioner; OA, occupational asthma.